Inferior branch–preserving superior head resection of the pancreas with gastric wall–covering method for intraductal papillary mucinous adenoma

Kuroki, Tamotsu; Tajima, Yoshitsugu; Tsutsumi, Ryuji; Mishima, Takehiro; Kitasato, Amane; Adachi, Tomohiko; Kanematsu, Takashi

doi:10.1016/j.amjsurg.2005.08.040

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…The results of the present study differ from those of other investigators' reports, which have indicated that branch duct type IPMN, especially smaller than 30 mm in size, is sufficient cause to apply limited resection of the pancreas (8, 19-21). Only 12 of 32 patients with main duct involvement had cysts larger than 30 mm in size.…”

Section: Discussioncontrasting

confidence: 99%

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

et al. 2011

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Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 ± 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.

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Section: Discussioncontrasting

confidence: 99%

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

et al. 2011

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“…Several reports have suggested that limited resection would be applied in branch duct type IPMNs [12][13][14][15]. Our results support this suggestion to some extent.…”

Section: Discussionsupporting

confidence: 94%

“…This suggests that simple cystic excision including enucleation could be unsafe due to the risk of tumoral involvement of the main duct. At the least, segmental resection of the pancreas is recommended for main duct involvement communicating with branch duct type IPMN [12][13][14]. Most series to date have only given suggestions whether to operate or not.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution

Hwang

Jang

Lee

et al. 2010

Langenbecks Arch Surg

115

106

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Purpose The clinical importance of intraductal papillary mucinous neoplasm of the pancreas (IPMN) has been increasing with a large number of newly diagnosed IPMN. This study was designed to explore the characteristics of resected IPMN and to determine the predictive factors for malignant and invasive IPMN. Methods Retrospective review of a prospectively collected database was performed on 187 consecutive patients following IPMN surgery between 1994 and 2008 at a tertiary institute. The main duct type IPMN was radiologically defined as main pancreatic duct dilation >5 mm rather than previously defined ≥10 mm. Results The morphologic types of IPMN included 28 main duct (IPMN-M, 15.0%), 118 branch duct (IPMN-Br, 63.1%), and 41 mixed (IPMN-Mixed, 21.9%) IPMNs. There were 23 patients with adenoma, 106 borderline atypia, 15 carcinoma in situ, and 43 invasive carcinoma. Sixty-nine extrapancreatic malignancies were diagnosed in 61 (32.6%) patients. Based on multivariate analysis, IPMN-M was statistically significant predictor of malignancy/ invasiveness (p=0.013/p=0.028). In patients with IPMNBr, the presence of mural nodule was a predictive factor for malignancy/invasiveness (p=0.005/p=0.002). In patients with IPMN-Mixed, mural nodule (p=0.038/p=0.047) and wall thickening (>2 mm, p=0.015/p=0.046) were risk factor for malignancy/invasiveness and elevated CA19-9 (p=0.046) for invasiveness. Conclusions The main pancreatic duct diameter (>5 mm) is a significant predictor for malignancy and invasiveness. Therefore, IPMN patients with main pancreatic duct dilatation (>5 mm) should be considered surgical resection. Mural nodule is the indicator of surgery in IPMN-Br and IPMN-Mixed. In case of IPMN-Mixed with wall thickening or elevated serum CA19-9, surgical resection is recommended.

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“…Our previous report described that intraoperative pancreatography using an endoscopic naso‐pancreatic drainage (ENPD) tube was useful for identifying the pancreatic ducts to be dissected and for preventing injury to the main pancreatic duct during open enucleation of pancreatic insulinoma . In addition, the ENPD tube in the main pancreatic duct was clearly and easily detected by intraoperative ultrasonography, and thus both the direction and position of the main pancreatic duct were correctly identified.…”

Section: Laparoscopic Enucleationmentioning

confidence: 99%

Laparoscopic parenchyma-sparing pancreatectomy

Kuroki

Eguchi

2013

J Hepatobiliary Pancreat Sci

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In recent years laparoscopic pancreatic procedures have developed rapidly, and reports of laparoscopic resection including laparoscopic distal pancreatectomy and laparoscopic pancreaticoduodenectomy have increased in number. On the other hand, many benign and low-grade malignant pancreatic lesions have recently been detected by the improved diagnostic modalities. Parenchyma-sparing pancreatectomy is a preferred surgical procedure for such benign and low-malignancy pancreatic lesions, because parenchyma-sparing pancreatectomy can avoid the unnecessary resection of the normal pancreatic parenchyma, thereby preserving the endocrine and exocrine functions of the pancreas. Simultaneously, laparoscopic surgery has contributed to minimally invasive approaches for various pancreatic surgical procedures. The combination of laparoscopic surgery and parenchyma-sparing pancreatectomy is an ideal surgical procedure for benign and low-grade malignant pancreatic lesions. For laparoscopic parenchyma-sparing pancreatectomy to become more widely known and its indications clarified, it is necessary to demonstrate the clinical benefits, technical feasibility, and safety of this complex and difficult surgical procedure.

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Inferior branch–preserving superior head resection of the pancreas with gastric wall–covering method for intraductal papillary mucinous adenoma

Cited by 7 publications

References 7 publications

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution

Laparoscopic parenchyma-sparing pancreatectomy

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